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NPI Code Detail

MEDICARE: CARISSA JO MYERS LMSW

MEDICARE: CARISSA JO MYERS LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker4081800ID

General Provider Information

NPI Number : 1457206476
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISSA JO MYERS LMSW
Provider Business Mailing Address
First Line : 1275 RIVERSIDE AVE
Second Line :
City : OROFINO
State : ID
Zip : 83544-6025
Country : US
Telephone Number : 208-476-7483
Fax Number : 208-476-3144
Provider Business Practice Location Address
First Line : 1275 RIVERSIDE AVE
Second Line :
City : OROFINO
State : ID
Zip : 83544-6025
Country : US
Telephone Number : 208-476-7483
Fax Number : 208-476-3144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2026
Last Update Date : 03/04/2026

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Directions to “ CARISSA JO MYERS LMSW” Practice Location

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